89Sr联合双膦酸盐在骨转移瘤姑息性治疗中的疗效观察

Therapeutic Effect of Internal 89 Sr Radio -therapy Combined with Bisphosphonate for the Palliative Treatment of Patients with Skeletal Metastases

目的观察单独使用89Sr、双膦酸盐及两种药物联合使用治疗骨转移瘤的疗效，对三种治疗方法进行评价，并对89Sr对造血系统的影响进行分析。方法回顾性统计骨转移瘤治疗病人115名，其中89Sr组36人，双膦酸盐组38人，联合用药组41人。收集观察对象冶疗前后视觉模拟评分（VualAnlogueScaleVAS）以及89Sr组和双膦酸盐组共77名使用过89Sr的患者的用药前后的白细胞数值。分别对比三组患者治疗前后的VAS评分进行治疗效果的分析，对比三组病人经过治疗后疼痛缓解的有效率，进行治疗方法效果差异分析，对比77名经历过89Sr治疗的患者不同时期的血细胞计数变化进行该药物对造血系统影响的分析。结果89Sr单药治疗组治疗前后VAS评分的变化支持89Sr治疗骨转移瘤改善患者生存状态疗效确定的结论（治疗前：4．311．47，治疗后：3．061．62，P〈0．05）。双膦酸盐单药治疗组治疗前后VAS评分数据说明双膦酸盐改善骨转移瘤患者生存状态疗效确切（治疗前：4．611．69，治疗后3．531．80，P〈0．05）。89Sr治疗前后白细胞与血小板计数、联合用药组治疗前后、及联合用药组二次入院血常规检查数据表明，89Sr会对造血系统产生可逆的一过性影响。三组观察对象治疗的有效率分别为69．44％，68．42％，92．68％。对三组进行有效率χ2检验=9．29，P〈0．05。说明三组有效率不同。进一步将三组进行两两对比。结果支持联合用药组有效率高于单独用药组。结论89Sr、双膦酸盐及双药联合使用对改善骨转移瘤患者生存状态疗效确切。联合用药有效率高于单独用药。89Sr会对造血系统产生一定的抑制作用，但为一过性反应，一般会在停药后恢复正常。

Objective To observe the effection of 89 Sr, bisphosphonate, and two drugs in combination in treating the patients with skeletal metastases. Methods To observe 115 patients totally, including 36 in 89Sr group and 38 of bisphosphonate group and combined group 41,We collected the mark of observed objects, including the visual analogue scale （VAS） . Furthermore, we also counted the number of the white blood cell and platelets numerical values of the patients who used the 89 Sr before and after they were cured. Contrast the changes which is marked by the VAS score of the three groups before and after their treatment in order to analyze the effect of treatment. Compared the efficient of the three groups to analyze the difference of the three methods. Analyze the effect of 89Sr on hematopoietic system by observating the changes of the number of the white blood cell and platelet. Results The VAS score changes of the 89 Sr groups supports the conclusion that 89Sr can improve the quality of life in patients with skeletal metastases （t =4.9378, P 〈 0.05） . The group using the bisphosphonate draw the conclusion that the medicine can improve the quality of life in patients with skeletal metastases by using the same statistical methods （VAS： t =4.558, P 〈 0.05） . The number of the white blood cell change before and after the curing （t =4.6709, P 〈 0.05） in the group of the 89 Sr. The number of the platelet also change （t =5.4073, P 〈 0.05 ） in the same group, In the group of combined treatment, the number of the white blood cells change before and after the curing （t =9.901, P 〈 0.05） , as same as the number of the platelet （t =8.6496, P 〈0.05） . The number of white blood cell （t =11.4246, P 〈 0.05） and platelet （t =8.3991, P 〈 0.05） both showed increasing trend when the patient of combination group come back.The data indicate that 89 Sr will produce a temporary effect which is reversible to the hematopoietic system.The treatment efficacy of the three groups is 69.44%, 68.42% and 92.68%. The efficiency of the combined treatment group is higher than the single drug group. The result of the chi-square test isχ2 =8.27, P 〈 0.05, χ2 =7.55, P 〈 0.01. Conclusion 89 Sr, bisphosphonate and dural -drug combined are all helpful in curing the patients with skeletal metastases with improving their living conditions. The efficiency of combined treatment is higher than using single drug. 89 Sr will produce a temporary effect which is reversible to the hematopoietic system and the effect will be removed after discontinue the medicine.